Sundowning: Late-day confusion

The term “sundowning” refers to a state of confusion that occurs in the late afternoon and lasts into the night. Sundowning can cause various behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning also can lead to pacing or wandering.

Sundowning isn’t a disease. It’s a group of symptoms that occurs at a specific time of the day. These symptoms may affect people with Alzheimer’s disease and other types of dementia. The exact cause of sundowning is not known.

Factors that may worsen late-day confusion

• Fatigue.
• Spending a day in a place that’s not familiar.
• Low lighting.
• Increased shadows.
• Disruption of the body’s “internal clock.”
• Trouble separating reality from dreams.
• Being hungry or thirsty.
• Presence of an infection, such as a urinary tract infection.
• Being bored or in pain.
• Depression.

Tips for reducing sundowning

• Keep a predictable routine for bedtime, waking, meals and activities.
• Plan for activities and exposure to light during the day to support nighttime sleepiness.
• Limit daytime napping.
• Limit caffeine and sugar to morning hours.
• Turn on a night light to reduce agitation that occurs when surroundings are dark or not familiar.
• In the evening, try to reduce background noise and stimulating activities. This includes TV viewing, which can sometimes be upsetting.
• In a strange or not familiar setting, bring familiar items, such as photographs. They can create a more relaxed setting.
• In the evening, play familiar, gentle music or relaxing sounds of nature, such as the sound of waves.

Some research suggests that a low dose of melatonin may help ease sundowning. Melatonin is a naturally occurring hormone that induces sleepiness. It can help when taken alone or in combination with exposure to bright light during the day.

It’s possible that a medicine side effect, pain, depression or other condition could contribute to sundowning. Talk with a healthcare professional if you suspect that a condition might be making someone’s sundowning worse. A urinary tract infection or sleep apnea could be contributing to sundowning, especially if it comes on quickly.